John Knox Preschool

Application for Admission

Application for Admission

ALL CHILDREN MUST BE POTTY TRAINED

We are so excited you chose John Knox Preschool to begin your child's education.

Please complete the information and $75 registration fee. We add children to clast lists according to the date the application is completed AND the registration fee is paid.
SCHOOL YEAR*
- 2025-26
- 2026-27
Please choose the program:*
- 3 Year Old Class, Thursday and Friday 9:00 AM-11:30 AM
- 4/5 Year Old Am Class, Monday, Tuesday, Wednesday 9:00-12:15pm
- Enrichment Class, Thursday 12:30-2:30
How did you learn about John Knox Preschool?*
Child’s Information
Child's Name*
First Middle Last
Gender*
- Male
- Female
Age*
Date of Birth*
Date Format: MM slash DD slash YYYY
Race*
Home Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Home Phone*
Any Allergies?*
- Yes
- No
Allergies (Please Specify)*
Doctor Name*
Doctor’s Phone Number*
Any Medication?*
- Yes
- No
Medications (Please Specify)*
Please choose the program:(not in use)
SCHOOL YEAR (not in use)
Family Information
Parent/Guardian #1
Parent/Guardian #1 Name*
First Last
Relationship to Child*
Cell Phone*
Email Address*
Work Phone*
Occupation*
Workplace*
Workplace Address*
Parent/Guardian #2
Parent/Guardian#2 Name*
First Last
Relationship to Child*
Cell Phone*
Email Address*
Work Phone*
Occupation*
Workplace*
Workplace and Address*
In the event of an emergency, if the parents cannot be reached, please contact:
Emergency Contact #1*
Name Address Phone Relationship
Emergency Contact #2*
Name Address Phone Relationship
Do both parents now live with the child?*
- Yes
- No
If not, which parent has custody?*
List names and dates of birth (DOB) of other children in the family:*
Name DOB

Click ⊕ sign to add more
Are you a member of John Knox Church?*
- Yes
- No
Family Member’s Name*
Have you ever had a child enrolled at John Knox Preschool?*
- Yes
- No
Name*
Year enrolled*
Child’s Personal History
What name does the child use at home?*
What does your child like to do at home or away from home?*
What does your child like to play at home or away from home?*
What can you tell us about your child that would help us to understand him/her better?*
What do you want your child to learn from his/her preschool experience?*
What concerns do you have about your child’s socialization skills, educational skills, speech or occupational skills, or behaviors? (Please address each area.)*
Are there any additional notes we should know about your child?*
Not in use - NO OUTSIDE USES OF THIS INFORMATION ARE APPROVED.
- I WOULD like my name and telephone number to be included in this roster.
- I WOULD NOT like my name and telephone number to be included in this roster.
Registration fee
Price: $75.00
Signature*
Date*
Date Format: MM slash DD slash YYYY

Please note that all information provided on this form will be kept confidential.
Your signature confirms that the information you entered here is correct and true to the best of your knowledge. You will need to update us if something changes.

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Name	DOB

John Knox Preschool

Application for Admission

Child’s Information

Family Information

Parent/Guardian #1

Parent/Guardian #2

In the event of an emergency, if the parents cannot be reached, please contact:

Child’s Personal History

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